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LOVIT. Over 800 patients. Multicentre RCT. Seems well done. Vitamin C demonstrates clear harm. Good bye Vitamin C.
I've worked at tertiary centres where this was being used. Makes me feel a little sick.
I have to be honest and say I was a little bit excited after CITRIS-ALI. But I'm becoming ever more cynical and jaded and better understanding of my older colleagues who've seen it all before when it comes to new trials.
Also: Van den Berghe with the Leuven trials and tight glycemic control. Rivers and EGDT. Marick and his cocktail. You either die a hero or live long enough to become the villain.
Also: low tidal volumes, antibiotics, arguing about source control, and being meticulous about not doing anything stupid. Is that all we have to offer as a speciality? I'm only half joking. It's painful to see yet another negative trial.
Conclusion:
In adults with sepsis receiving vasopressor therapy in the ICU, those who received intravenous vitamin C had a higher risk of death or persistent organ dysfunction at 28 days than those who received placebo.
Methods:
In this randomized, placebo-controlled trial, we assigned adults who had been in the ICU for no longer than 24 hours, who had proven or suspected infection as the main diagnosis, and who were receiving a vasopressor to receive an infusion of either vitamin C (at a dose of 50 mg per kilogram of body weight) or matched placebo administered every 6 hours for up to 96 hours. The primary outcome was a composite of death or persistent organ dysfunction (defined by the use of vasopressors, invasive mechanical ventilation, or new renal-replacement therapy) on day 28.
Results:
A total of 872 patients underwent randomization (435 to the vitamin C group and 437 to the control group). The primary outcome occurred in 191 of 429 patients (44.5%) in the vitamin C group and in 167 of 434 patients (38.5%) in the control group (risk ratio, 1.21; 95% confidence interval [CI], 1.04 to 1.40; P=0.01). At 28 days, death had occurred in 152 of 429 patients (35.4%) in the vitamin C group and in 137 of 434 patients (31.6%) in the placebo group (risk ratio, 1.17; 95% CI, 0.98 to 1.40) and persistent organ dysfunction in 39 of 429 patients (9.1%) and 30 of 434 patients (6.9%), respectively (risk ratio, 1.30; 95% CI, 0.83 to 2.05). Findings were similar in the two groups regarding organ-dysfunction scores, biomarkers, 6-month survival, health-related quality of life, stage 3 acute kidney injury, and hypoglycemic episodes. In the vitamin C group, one patient had a severe hypoglycemic episode and another had a serious anaphylaxis event.
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